LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 105 a. Prevention b. Therapeutic approach 1. Recognize that the presence of aspiration and the degree of airway obstruction are the primary indicators of need for therapy in patients with vocal cord paralysis 2. Recognize that temporary relief of the symptoms of vocal cord paralysis can be provided by the use of continuous positive pressure 3. Recognize that decompression surgery is required to relieve vocal cord paralysis secondary to Arnold-Chiari malformation 6. Prognosis a. Know the natural history of vocal cord paralysis secondary to birth trauma and cardiac surgery g. Subglottic stenosis 1. Epidemiology a. Recognize that chronic subglottic stenosis occurs in congenital and post-traumatic forms b. Recognize that even brief periods of intubation may result in chronic subglottic stenosis 2. Etiology/Genetics 3. Pathophysiology a. Pathology b. Path mechanisms and consequences 1. Recognize the role of airway inflammation secondary to trauma in the pathogenesis of acquired subglottic stenosis 2. Recognize that the cricoid cartilage, because it is a complete ring, is predisposed to traumatic injury and stenosis 4. Diagnosis and clinical manifestations a. History 1. Recognize the importance of a history of recurrent croup or a protracted croup illness in identifying a population with underlying subglottic stenosis 2. Recognize the importance of a history of previous intubation or airway instrumentation in alerting the clinician to a diagnosis of acquired chronic subglottic stenosis b. Physical examination 1. Know that significant subglottic stenosis acts as a fixed upper airway obstruction and causes noisy breathing on both inspiration and expiration 2. Recognize the relationship between the pitch of stridor and the severity of the obstruction in chronic subglottic stenosis 3. Recognize the physical findings (retractions, flaring, high-pitched stridor, diminished air entry) associated with significant subglottic stenosis c. Imaging 1. Recognize the lack of correlation between the radiographic appearance of subglottic stenosis and the actual degree of narrowing on endoscopy